No-Fault Case Law

The relevant facts considered by the court included a motion by the defendant to vacate a default judgment entered after the defendant failed to proceed at trial. In support of its motion, the defendant submitted an affidavit by the plaintiff's assignor admitting that the accident for which the plaintiff was seeking no-fault benefits had been staged. Additionally, the defendant provided an order from the Supreme Court, New York County, in a declaratory judgment action, finding that the defendant had no duty to pay any no-fault benefits to the plaintiff and its assignor. The main issue decided by the court was whether the defendant demonstrated a reasonable excuse for its failure to proceed at trial and a meritorious defense. The court ultimately held that the defendant's motion should have been granted, as it did demonstrate a reasonable excuse for its failure to proceed at trial and a meritorious defense. Therefore, the order denying the defendant's motion to vacate the default judgment was reversed, and the defendant's motion to vacate the default judgment was granted.

The main issue in this case was whether the decision of the Civil Court to dismiss the complaint was proper, as the plaintiff had allegedly defaulted by failing to comply with a condition set by the court for the granting of an adjournment of the trial. The Appellate Term held that although no appeal lies from a judgment entered on the default of the appealing party, an appeal from such a judgment brings up for review those matters which were the subject of contest below. The Appellate Term determined that the Civil Court had acted within its discretion in conditioning the granting of an adjournment of the trial upon the plaintiff's providing proof of the funeral that its witness had allegedly been attending, but found that the Civil Court improvidently exercised its discretion in not allowing plaintiff's witness to testify in order to try to provide the required proof. Therefore, the judgment was reversed, and the matter was remitted to the Civil Court for a new determination, following a hearing, of whether plaintiff had satisfied the condition for the granting of an adjournment and for any and all further proceedings.

The court considered various documents and witness testimony related to the rescission of an automobile insurance policy, specifically the misrepresentations made in the insurance application. The main issue decided was whether the rescission of the policy was proper and whether the insurer was liable for payment under New York's No-Fault Law. The court ultimately held that the insurer met its burden of showing that the insured's statements were untrue, material to the risk, and made with the intent to mislead and defraud the insurer. As a result, the court dismissed the lawsuit with prejudice, ruling in favor of the defendant insurer.

The court considered the plaintiff's motion for summary judgment to recover assigned first-party no-fault insurance benefits, as well as the defendant's cross motion seeking dismissal of the complaint. The main issue decided in this case was whether the defendant had failed to deny the claims within the requisite 30-day period or issued timely denials that were conclusory, vague, or without merit as a matter of law. The court held that the plaintiff did not establish that the defendant had failed to deny the claims within the required period, and as a result, the plaintiff's motion was denied. Additionally, the court addressed the defendant's cross motion, stating that the failure of the plaintiff's assignor to attend IMEs constituted a violation of a condition precedent to coverage. However, the defendant failed to establish that the IME notice sufficiently apprised the assignor of the right to reimbursement for lost earnings and transportation expenditure, and as a result, both the plaintiff's motion and the defendant's cross motion were denied.

The main issue in this case was whether the insurance company properly cancelled the policy due to nonpayment of the premium before the accident at issue. The court considered whether the insurance company had mailed its cancellation notice in accordance with the applicable statute. The court found that the insurance company failed to demonstrate that it had mailed the cancellation notice by registered or certified mail as required by law. Therefore, the court held that the branch of the insurance company's motion seeking summary judgment dismissing the complaint on the ground of lack of coverage was denied, and the matter was remitted to the Civil Court to determine the remaining branch of the insurance company's cross motion. The court also found that the healthcare provider failed to demonstrate its entitlement to judgment as a matter of law with regards to the claims at issue, and the order was modified accordingly.

The court considered the fact that Bay Plaza Chiropractic, P.C. was seeking to recover assigned first-party no-fault benefits, and defendant Auto One Insurance Company sought summary judgment dismissing the complaint or, alternatively, to compel plaintiff to appear for an examination before trial. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The court held that while there was a triable issue of fact regarding the medical necessity of the services, defendant was entitled to compel plaintiff to appear for an examination before trial, as it was material and necessary to defendant's lack of medical necessity defense. Therefore, the branch of defendant's motion seeking to compel plaintiff to appear for an examination before trial was granted.

The case involved an appeal from an order of the Civil Court denying the plaintiff's motion for summary judgment and granting the defendant's cross motion to compel the plaintiff to respond to discovery demands and to produce the plaintiff for an examination before trial. The plaintiff was a provider seeking to recover assigned first-party no-fault benefits. The court held that the plaintiff's motion for summary judgment was properly denied because the proof submitted by the plaintiff failed to establish that the claims had not been timely denied or that the defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law. Additionally, the court ruled that the plaintiff was obligated to produce the information sought in the discovery demands, as the plaintiff failed to timely challenge the propriety of the demands. The defendant was entitled to an examination before trial of the plaintiff, and the court affirmed the order.

The court considered a case in which a medical provider was attempting to recover no-fault benefits from an insurance company after an alleged accident. The insurance company had moved for summary judgment to dismiss the complaint, arguing that the insured vehicle was not involved in the accident. The court considered the transcript of the examination under oath of the insured, where she testified that no accident had occurred and that the plaintiff's assignor, a pedestrian, had not been struck by her vehicle. The court found that this was sufficient evidence to demonstrate that the alleged injury did not arise out of an insured incident, and as the plaintiff had failed to raise a triable issue of fact in opposition to the motion, the order granting the insurance company's motion for summary judgment was affirmed.

The court considered the denial of a motion for summary judgment by the plaintiff and a cross-motion for summary judgment by the defendant in a case involving a provider trying to recover assigned first-party no-fault benefits. The court found that the plaintiff had established that it had mailed the bill to the defendant, that the bill was unpaid, and that the defendant had timely denied the claim. The main issue decided was whether the defendant had a basis for denying the claim, specifically related to the assignor fraudulently procuring the insurance policy by misrepresenting her address to obtain a lower premium. The holding of the court was that the defendant failed to establish as a matter of law that it would not have issued the same policy if the correct information had been disclosed in the application, and that the doctrine of collateral estoppel was not applicable as the plaintiff was not named in the related action.

The court considered a dispute involving Nationwide and State Farm insurance companies over their obligation to defend and indemnify Lisette Oster in a wrongful death action. The case revolved around an incident where Lisette's negligent actions allegedly led to Mr. Daniele's death. Nationwide denied coverage, claiming the incident fell under an automobile policy exclusion, while State Farm asserted it had no obligation to defend. The main issues included the interpretation of insurance policies, the duty to defend, and the alleged bad faith of Nationwide. The court held that Nationwide must provide coverage and defend Lisette, as its duty was broader than the duty to indemnify. State Farm was not obligated to defend Lisette. The court also allowed Lisette to recover attorney's fees, but Mrs. Daniele was not entitled to do so. Finally, the court dismissed the complaint and granted Lisette's counterclaims.